Alzheimer's

DEFINITION

Alzheimer's disease is the most common form of dementia. It is a degenerative disease leading to the loss of important brain cells. This causes symptoms that may include confusion, memory loss, impairment of reasoning and rationality, restlessness, speech disturbances, exaggerated emotional reactions and other problems that generally show a progressive deterioration.

DESCRIPTION

As the population grows older, the incidence of Alzheimer's disease is increasing. Studies show that 1 in 5 people over 80 may suffer from the disease. Alzheimer's disease goes through several stages until the severe form of dementia develops. It is difficult to diagnose and sometimes the person with Alzheimer's might have to be referred to a specialist such as a geriatrician.

The course of this disease is quite variable often with a gradual onset. Early symptoms include problems in remembering recent events and difficulty performing familiar tasks or learning new ones. There may be changes in personality and behaviour, impaired judgement and difficulty in finding words and finishing thoughts. Confusion occurs about the time of day and the date. Some people with Alzheimer's believe that the present day is actually some time in the past and may talk about an event from many years ago, as if it were happening today.

As the disease progresses it may deprive the person of the ability to care for themselves. It has been suggested that people with Alzheimer's can suffer much confusion and distress from struggling with the frustrations of everyday life.

ALZHEIMER'S AND DEMENTIA
A commonly asked question is "what is the difference between Alzheimer's disease and dementia"?

Dementia is a term that is used to describe a group of symptoms and is not a disease in itself. These symptoms include; loss of memory, confusion, disorientation, personality changes etc. There are many different forms of dementia and each has its own cause. Alzheimer's disease is the most common form of dementia, accounting for between 50 and 70 percent of all cases. Other forms include vascular dementia, dementia associated with progressed Parkinson's disease, dementia with Lewey bodies, Frontal Temporal Lobar Degeneration (FTLD), Huntington's disease, Alcohol-related dementia (Korsakoff's syndrome), Creutzfeldt-Jacob disease etc.

CAUSE

No conclusive cause of Alzheimer's disease has been determined. However, the following characteristics of Alzheimer's can be noted:
- A connection with certain chemical messengers appears to be present.
- The nerve cells that die as a result of Alzheimer's Disease often contain the chemical messenger called acetylcholine.
- People with Alzheimer's have been found to have lowered levels of the key enzyme choline acetyltransferase in their brains. This enzyme is needed to form the chemical messenger acetylcholine.
- Attempts to increase brain levels of acetylcholine using medicines have been unsuccessful.
- Low levels of other messengers in the brain may also play a role (e.g. serotonin and noradrenaline).
- 5-10% of cases run in families. In some cases, defects in a particular chromosome are linked with the disease.

RISK FACTORS
The following genetic, behavioral, and environmental risk factors all appear to contribute to the development of Alzheimer's disease.
* Age

A person with Alzheimer's disease should be under the care of a Doctor and be carefully monitored. Symptoms such as depression and agitation usually can be alleviated by prescription drugs. Areas to look at include a complete medical history, a thorough physical and neurological examination, a mental status test, a psychiatric assessment and tests for comprehension and insight. Early diagnosis is very important as a means of ruling out treatable causes of dementia and to check for complicating conditions. New image-making techniques such as MRI (magnetic resonance imaging) may also be used.

Recommendations for the prevention and management of early stage Alzheimer's disease include;
* Weight loss and having a healthy diet;
* Reduction of elevated cholesterol levels and high blood pressure; and
* Complex leisure activities with physical, mental, and social interactivity components.

Supportive measures can be taken to help a patient feel more comfortable and reduce behavioural disturbances.

1. Allow the person to have personal belongings and familiar objects nearby, such as photographs.
2. Encourage orientation with a clock and calendar.
3. Keep the environment pleasant and calm by reducing noise, ensuring adequate lighting and minimising clutter.
4. Ensure any treatable deficits are corrected (hearing aids, glasses, dentures etc).
5. Use television, radio or music for relaxation but not as a substitute for activity.
6. Maintain social activity and mobility levels as much as possible.
7. Ensure basic physical needs are met (food, water, warmth, cleanliness etc).

DIET HINTS

- The diet for this ailment should be directed towards keeping the person with Alzheimer's as physically healthy as possible. If the person has other medical problems, the severity of the Alzheimer's symptoms may be increased. Concentrate on food that is fresh. Eat raw or lightly steamed vegetables if possible to retain the maximum nutrient content. Include the green leafy variety of vegetables daily, as these are a rich source of vitamins and minerals. Studies have shown that individuals with diets high in fruit, fibre, folic acid, vitamin C, beta-carotene, iron and zinc, and lower intakes of saturated fats have improved cognitive function compared with those who do not.
- Make sure that the diet contains an adequate amount of protein-rich foods, which include lean meats, fish, eggs, chicken (without the skin), nuts, seeds, peas and beans.
- Oysters are an excellent dietary source of zinc.
- Keep the intake of sugar and refined carbohydrates to a minimum. Examples of these foods include sugar, honey, glucose, cakes, biscuits, chocolate, puddings, jam and icecream. Foods that contain white flour are not recommended as these are generally lower in vitamin content and high in calories.
- Animal and vegetable fats are to be moderated in a healthy diet e.g., butter, milk and cheese as well as coconut and palm oil. Try to always cook with olive oil which is a stable oil and less likely to cause damage to cells within the body than other cooking oils.
- Keep the bodyweight to a reasonable level.
- Avoid added salt and watch alcohol consumption.

PREVENTION

Fruit and vegetable juices may play an important role in delaying the onset of Alzheimer's disease, particularly among those who are at high risk for the disease.

- If the diet is inadequate a multi-vitamin with antioxidants may help to provide additional nutrients to support good health.

- Ginkgo biloba is a herb which may be helpful in some cases of early stage Alzheimer's disease and vascular dementia Ask your Pharmacist for advice about dosage and contraindications.

Note: If a patient is taking low dose aspirin or prescribed anticoagulants it is advisable to start on low doses of Ginkgo biloba under the supervision of a medical practitioner.

ORGANISATIONS & SUPPORT GROUPS

See the Alzheimer's Association of Australia topic on the Healthpoint.

PHARMACIST'S ADVICE

1) Follow the Diet Hints.
2) Have regular exercise to help stimulate blood circulation.
3) Introducing mental stimulation, within the patients' ability, may be of benefit. It is thought that lack of mental stimulus may worsen the symptoms or promote the onset of Alzheimer's. Ask your health care professional for advice.
4) If the diet is inadequate a multi-vitamin with antioxidants may help to provide additional nutrients to support good health.
5) A clinical study has shown that smokers have an increased risk of developing Alzheimer's disease and other forms of dementia. Ask your Pharmacist for advice about quitting smoking.